Payor of Last Resort Tribal Presentation

TRIBAL SELF-INSURED HEALTH PLANS
PAYOR OF LAST RESORT
Presented by:
Tyler Moore, Mattecheck & Associates and Face Rock Enterprises
PAYOR OF LAST RESORT - OVERVIEW
Under 25 U.S.C § 1623(b) the Tribe becomes the
payer of last resort for claims incurred by a
Contract Health Services (CHS) eligible
member/employee
 All other coverage would be primary including:

 Coverage
under a spouse’s health plan
 Coverage under Medicare
 Coverage under Medicaid
PAYOR OF LAST RESORT – FINANCIAL BENEFIT
Positively impacts the CHS and Health Plan
budget by shifting claims cost to other payers
without impacting the members out-of-pocket
(both the Tribal Member Plan and the Employer
Sponsored Plan)
 Impact varies drastically based on:

 Number
of CHS eligible employees
 Number of Tribal Members who have other
coverage
PAYOR OF LAST RESORT – KEY FEATURES
The Tribe’s health programs must be selffunded
 The health plan documents must have the
correct language included
 The Tribe and/or the health plan third party
administrator (TPA) must correctly manage
eligibility
 The Tribe’s TPA must understand how to apply
and enforce the Payor of Last Resort

PAYOR OF LAST RESORT - CONSIDERATIONS
Partner with a subject matter expert to help set
up and manage the Tribe’s health programs
 Find the right third party administrator (TPA)
 Conduct a coordination of benefit (COB) audit
 Provide Tribal Member assistance – enrolling in
Medicare/Medicaid

PAYOR OF LAST RESORT – QUESTIONS?
Questions?
Tyler Moore
[email protected]
(541) 504-4139